title: Long-term effectiveness of intralesional triamcinolone acetonide therapy in orofacial granulomatosis: an observational cohort study.
abstract: BACKGROUND
  It has been suggested that intralesional triamcinolone injections represent a safe and effective therapeutic strategy in controlling the permanent disfiguring swelling of orofacial granulomatosis (OFG). However, robust supporting evidence is lacking, due to the variable and inconsistent design of available studies.
  
  
  OBJECTIVE
  To investigate whether a standardized regimen of intralesional triamcinolone has beneficial long-term effects on orofacial swelling of OFG. We also studied potential associations with a number of prognostic factors.
  
  
  METHODS
  We designed a retrospective observational study of a homogeneous cohort of 22 well-phenotyped patients with OFG. The primary outcome was defined as a statistically significant decrease in post-treatment disease severity. Statistically significant association with prognostic factors was the secondary outcome. Statistical analysis included Wilcoxon signed-rank tests and logistic regression.
  
  
  RESULTS
  Compared with pretreatment, there were statistically significant decreases in disease severity scores at all time points until 48 months post-treatment (P < 0·01). Logistic regression analysis showed there was no independent prognostic variable of statistical significance (P > 0·05). The majority of patients (14/22, 63·6%) received one course of intralesional triamcinolone and did not experience disease recurrence. The mean disease-free period after the first course of intralesional therapy was 28·9 ± 18 months (95% confidence interval 28·7-29·1). No adverse effects were reported.
  
  
  CONCLUSIONS
  This is the first study to have employed robust cohort methodology and sound statistics to demonstrate long-term effectiveness of intralesional triamcinolone in controlling the disfiguring swelling of OFG. Because of limitations inherent in observational studies, further research in the form of randomized case-control trials is needed to confirm the present findings.
authors.affiliation: University College London/University College London Hospital, Eastman Dental Institute and Hospital, Oral Medicine Unit, 256 Gray's Inn Road, London, WC1X 8LD, U.K; NIHR Biomedical Research Centre at University College London Hospital NHS Foundation Trust and University College London, Maple House Suite A 1st floor, 149 Tottenham Court Road, London, W1T 7DN, U.K.
authors.forename: S
authors.initials: S
authors.lastname: Fedele
authors.forename: P P L
authors.initials: PP
authors.lastname: Fung
authors.forename: N
authors.initials: N
authors.lastname: Bamashmous
authors.forename: A
authors.initials: A
authors.lastname: Petrie
authors.forename: S
authors.initials: S
authors.lastname: Porter
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015986:Confounding Factors, Epidemiologic; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D051261:Granulomatosis, Orofacial / Q000188:drug therapy*; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage* / Q000009:adverse effects; D055815:Young Adult
chemical_list: D005938:Glucocorticoids; D014222:Triamcinolone Acetonide